22 November 2015

Although you wouldn't know it, the UK's Department of Health has been running a consultation on NHS England. It has kept this quiet in the hope that no one would reply, and it could just do what it wanted.

You can read its consultation document pretty quickly, but it probably won't do much good: it's written in the finest officialese that manages to sound impressive, but say very little. You can respond online, and here's what I've sent them:

Do you agree with
our aims for the mandate to NHS England?

Although the mandate
is largely fine, it suffers from an excess of generalities. What it
lacks is any concrete statement of about how things should be done.
I think it is vital that the NHS should be committed to providing a
world-class health service using public resources, not private ones.
The reasons are simple.

First, the US health
system shows us that private healthcare is incredibly expensive,
incredibly inefficient, and fails to deliver good healthcare. Moving
in that direction would be foolish at best, and downright negligent
at worst, since people will die as a direct consequence of doing so.

Moreover,
privatising healthcare is foolish for economic reasons: private
providers by definition must make a profit, and so by definition are
more expensive than publicly-provided resources. Invoking
"competition" as a reason why private health provision is
better makes no sense, since that competition leads to cost-cutting,
which again leads to patients suffering, as recent experiences have
shown here in the UK.

Finally,
privatisation makes no sense because there is no ownership of skills
and knowledge. This would make the NHS a hollow, precarious
structure.

Is there anything
else we should be considering in producing the mandate to NHE
England?

Yes: it should
specify as a matter of principle that services will provided
publicly, not through private provision. The use of private
contractors by public bodies is fine, but the control of every key
aspect must remain in public, not private hands, otherwise the profit
principle takes over, and people will suffer.

What views do you
have on our overarching objective of improving outcomes and reducing
health inequalities, including by using new measures of comparative
quality for local CCG populations to complement the national outcomes
fin the NHS Outcomes Framework?

Fine words again,
but without adequate resources, essentially worthless. Unless the
NHS is funded adequately, as a matter of priority, it will be
impossible to achieve those fine objectives. This will lead to the
NHS being dubbed a "failure", which a cynic might suspect
is the intention so that privatisation can be offered as the
"solution." It is not.

What views do you
have on our priorities for the health and care system?

The key priority
should be providing world-class healthcare to everyone in the UK free
of charge. That is the sign of a civilised country, and failing to
do so is to fail that test too. Of course, that requires more
resources, in which case it becomes a matter of priorities. But far
more lives will be lost as a result of underfunding the NHS than will
be lost through terrorism, however much the government likes to
exaggerate the threat of the latter. Indeed, the greatest threat to
this country is not ISIS/Daesh but things like the end of
antibiotics, which could see all major surgery becoming impossible in
just a few years. The government should be spending its billions on
researching new ways of killing bacteria, not beefing up its
surveillance apparatus.

What views do you
have on how we set objectives for NHS England to reflect their
contribution to achieving our priorities?

Despite all the
claims of openness, this consultation has been conducted in
near-secrecy. If the government really cared about what the public
thinks on this matter (and I do realise that it does not), it would
have made far greater efforts to publicise the existence of this
consultation. Given the government is now trying to emasculate FOI
requests, this is hardly a surprise, but I find the emphasis on
openness here a little galling, to say the least.

About Me

I have been a technology journalist and consultant for 30 years, covering
the Internet since March 1994, and the free software world since 1995.

One early feature I wrote was for Wired in 1997:
The Greatest OS that (N)ever Was.
My most recent books are Rebel Code: Linux and the Open Source Revolution, and Digital Code of Life: How Bioinformatics is Revolutionizing Science, Medicine and Business.